GERONTOLOGY

UNIT III
WELLNESS RELATED ISSUES
Violet Wright
 OBJECTIVES
At the end of this session, students will:
•Review concepts related to wellness.
•State components of wellness that should be
considered in caring for older persons.
•Sense the importance of including a wellness
perspective in caring for older persons.
•Apply wellness components to the care of the
older persons
 ACTIVITY
• Think for a minute, what does wholeness of
being look like / feel like?
• Transfer those thoughts to the older adult,
does it look or feel any different? If so in what
ways?
MASLOW’S HIERACHY OF NEEDS
THE HEALTH PROMOTION-
RELATED NEEDS
 THE HOLISTIC MODEL
• Holistic pertains to whole person; body, mind and
spirit.
• Demonstrates that optimal health includes those
activities that not only enable us to exist but also
helps us to realise effective, enriched lives.

Source: Gerontological Nursing (2014)

IMPROVED DEFINITION OF HEALTH
• A state of wholeness… an integration of body,
mind and spirit to achieve the highest possible
quality of life each day.

• Optimal health of the older person rests on

the degree to which the needs for
physiological balance, connection, and
gratification are satisfied.
 OTHER HEALTH CHALLENGE-
RELATED NEEDS
Apart from the physiological needs, needs for connection and
gratification; older adults have other needs inclusive of:
•Education
•Counselling
•Coaching
•Monitoring
•Coordinating
•Therapies
 REQUISITES TO MEET NEEDS
In order to meet the needs of older adults the
following are required; knowledge of these will
guide the nurse’s level of intervention:
•Physical, mental, and socioeconomic abilities
•Knowledge, experience and skills
•Desire and decision to take action
 DETERMINING CLIENT ABILITY
• Can the client meet needs independently or is
there a deficit?
• If there is a deficit then the nurse will need to
intervene by:
– Strengthening self care capacity
– Eliminating or minimising self care limitation
– Act for, do for, or partially assist
 WELLNESS
• Wellness, as contrasted to health, is an
ongoing dynamic process in the state of
becoming; it is the prime objective of health
promotion and disease prevention.
 WELLNESS RELATED ISSUES

•Physical
– Hygiene
– Nutrition / Hydration
•Rest, sleep and activity
•Safety
•Intimacy and sexuality
•Spirituality
 WELLNESS
HYGIENE
The nurse needs to give special care to the
hygiene of the older person, areas of focus are:
• Skin especially pressure points
• Hair
• Face, eyes, ears, mouth and nose
• Feet, hands and nails
• Pubic / rectal areas
 WELLNESS
HYGIENE
• In meeting the hygienic needs; the nurse should
integrate other activities such as physical assessment,
wound status and range of motion exercises.
• Maintain client’s privacy, comfort, and safety
• Be culturally sensitive
• If necessary / administer ordered, relieve pain prior to
care
• Older diabetic client needs special attention to foot
care and nails
 WELLNESS
HYGIENE
• Family members may assist as per agency
policy
• Client’s room should be comfortable, safe,
and large enough to allow the client and
visitors to move about freely
• Evaluation of hygiene care is based on client’s
comfort, relaxation and wellbeing.
 WELLNESS
NUTRITION
• The Bible states, “Whether therefore you eat
or you drink ... do all to the glory of God.
• E.G. White in Ministry of Healing states “In
order to maintain health, a sufficient supply of
good, nourishing food is needed.
 WELLNESS
NUTRITION
• A balanced dietary intake, using the Food
Guide Pyramid and the Healthy People 2020
guidelines, can promote nutritional health.
• Nurses in collaboration with key members of
the health team have the awesome
responsibility to guide the older persons and
their relatives in selecting appropriate foods.
 WELLNESS
NUTRITION
• In many cultures including our own, research
shows that many older persons do not consume
sufficient amounts of fruits, vegetables and
whole grains.
• Discuss some fruits, vegetables and whole
grains that you like / dislike and state why.
• Do you think that this preference will change
when you get older?
 WELLNESS
Factors related to eating of food
• CULTURE especially religion and festive
holidays
• psychosocial
• Socioeconomic
• Emotional
• Physiological
 WELLNESS
NUTRITION - Factors impacting nutrition of Older Persons
• Gender (females-less fats and breast cancers)
• Quantity / Quality of food
• Oral health
• Indigestion / Food intolerance
• Age related changes in G.I system
• G.I. Diseases (Anorexia, Dysphagia, Constipation,
Malnutrition)
• Use of supplements
 WELLNESS
NUTRITION- A comprehensive assessment of the
elderly would include:
• Data collection including
– Demographic / psychosocial data
– Medical history
– Dietary history
– Anthropometrics
– Medications
– Laboratory values including HIV / AIDS status
– Physical assessment (focus on G.I system)
 WELLNESS
NUTRITION – Dietary Guidelines
• Eat a variety of foods see Food Guide Pyramid
– Choose diet with plenty vegetables, fruits and whole
grains
– Use sugars and salts in moderation
– if alcohol do so in moderation
– Choose a diet low in fat, saturated fats and
cholesterol
• Maintain a healthy weight
• Proper hydration on a daily basis
• Seek assistance of nutrition specialist
 WELLNESS
NUTRITION – Specialised Nutritional Support
TYPES OF SUPPORT
• Proper fitting dentures
• Nutrition Health Professional
• NG tubes
• Gastrostomy tubes
• Jejunostomy
INDICATIONS
• CVA
• Coma
• Myastenia Gravis
• GI obstruction e.g Cancers
 WELLNESS
HYDRATION
•With age, intracellular fluid is lost, resulting in
decreased total body fluids.
•Water comprises 50% or less of body weight in
older adults.
•Recommended fluid intake equivalent to 11-15
glasses of 8oz, unless otherwise contraindicated.
•Critical to evaluate for factors that lead to
reduced water consumption.
 WELLNESS
HYDRATION
Reduced fluid intake exposes older adults to:
•Dehydration
•Infection
•Constipation
•Decreased bladder distensibility
•Serious fluid and electrolyte imbalances
 WELLNESS ISSUES
REST/ SLEEP/ACTIVITY
• Sleep and activity are like the two sides of a
coin both go together to fulfil our day’s
experience.
• The normal aging process may affect the sleep
– wake cycle of the older person.
• Insomnia, daytime sleepiness and napping are
all highly prevalent among the older adult.
 WELLNESS ISSUES
REST/ SLEEP/ACTIVITY
Normal Stages of Sleep include 5 stages, the
aging process affects the amount of time that
normally occurs in each stage, which results in
sleep disorders / insomnia.
• Non-REM
– Light sleep
– Medium sleep
– Medium deep sleep
– Deep sleep
• REM sleep
– Active sleep
 WELLNESS ISSUES
REST/ SLEEP/ACTIVITY – ISSUES
• Insomnia includes:
– Difficulty falling asleep
– Difficulty staying asleep
– Frequent nocturnal awakenings
– Early morning awakenings
– Daytime somnolence
 WELLNESS ISSUES
REST/ SLEEP/ACTIVITY - Factors affecting sleep
– Environment – altered perception of
day/night (? To vision/hearing defects)
– Hospitals and nursing homes
– Noise
– Lighting
– Temperature
– Pain and discomfort
 WELLNESS ISSUES
REST/ SLEEP/ACTIVITY – Factors Affecting Sleep
Lifestyle Changes
– Loss of spouse
– Retirement
– Relocation
– Roommate
– Dietary influences
– Drugs
 WELLNESS
Promoting Rest / Sleep / Activity
•Keep active during the daytime, interspersed
with rest periods.
•Modify environment to facilitate RSA.
•Manage stress related factors by
– Lifestyle changes
– Relaxation
– Spiritual engagements
•Pain control
 WELLNESS
SAFETY ISSUES
•Age related changes can reduce the capacity of
older persons to protect themselves from injury
and increase their vulnerability to safety
hazards. (Eliopoulos, 2014)
•Accidents rank as the sixth leading cause of
death in older adults, with falls leading the
cause of injury-related deaths.
 AGING AND RISK TO SAFETY
• Decreased in intracellular
• Poor condition of teeth
fluid
• Loss of subcutaneous; less • Weak gag reflex
natural insulation; lower • Altered taste sensation
basal metabolic rate
• Reduction in filtration
• Reduced strength and
elasticity of respiratory
of wastes by kidneys
muscles; decreased lung • Higher prevalence of
expansion; ineffective urinary retention
cough response; less ciliary
activity.
 AGING AND RISK FOR SAFETY
• Delayed response and
• Decreased muscle reaction time
strength • Poor vision and hearing
• Demineralisation of • Decreased efficiency of
bone the heart
• Reduced lacrimal • Less elasticity and more
secretion dryness and fragility of
skin.
• Distorted depth
perception • Poor short term memory
• Increased threshold for • High prevalence of poly
pharmacy
pain and touch
 WELLNESS ISSUES
SAFETY
Prevention is important because older adults require more
time to recover from injuries and suffer more complications.

RISK REDUCTION INTERVENTIONS

– Improvement in nutrition and hydration
– Correct sensory defects
– Address mobility limitation issues
– Monitor body temperature
– Prevent infections
 WELLNESS ISSUES
SAFETY
Prevention is important because older adults require more time to
recover from injuries and suffer more complications.

RISK REDUCTION INTERVENTIONS

– Suggest sensible clothing
– Use medications cautiously
– Avoid crime
– Promote safe driving
– Promote early detection of problems
– Addressing risks associated with functional
impairment
 WELLNESS ISSUES
FALLS– RISK AND PREVENTION
– Age related changes
– Improper use of mobility aids
– Medications
– Unsafe clothing
– Disease-related symptoms
– Environmental hazard
– Care-giver-related factors e.g use of
restraints
 WELLNESS ISSUES
INTIMACY AND SEXUALITY serves to foster the
need for connection and gratification.

MYTHS
• Women loose all sexual desire after
menopause
• Older men cannot achieve an erection
• Older people are not interested in sex
AGE-RELATED CHANGES & SEXUAL
RESPONSES
• Decrease in sexual responsiveness and a
reduction in the frequency of orgasm.
• Older men are slower to erect, mount and
ejaculate.
• Older women may experience dyspareunia –
less lubrication, thinning of vaginal wall
• Older women gain new insight in sex – no
pregnancy, children gone from home.
 WELLNESS ISSUES
INTIMACY AND SEXUALITY
BARRIERS TO SEXUAL ACTIVITY
• Impact of menopause / andropause
• Unavailability of a partner
• Psychological
• Medical conditions
• Erectile dysfunction
• Effects of medications
• Cognitive impairment eg Dementia
 WELLNESS ISSUES
INTIMACY AND SEXUALITY
FACTORS AFFECTING SEXUAL RESPONSES
• Illnesses, surgery, medications
• HIV and AIDS
• Malignancies
• Dementia
 WELLNESS ISSUES
INTIMACY AND SEXUALITY
PROMOTING HEALTHY SEXUAL FUNCTION
• Detailed sexual health history, incl HIV
• Education
• Willing and open discussion of sexuality
• Allowing couples to share same room
• Providing privacy
• Alternative to sexual intercourse
 WELLNESS ISSUES
Spirituality serves to foster the need for
connection and gratification.
•Spirituality ….. Religion
•Belief / faith normally include:
• Prayer
• Reading God’s words
• Attending worship sessions
• Fellowship with believers
 WELLNESS ISSUES
SPIRITUAL NEEDS
•Love
•meaning and purpose
•Hope
•Dignity
•Forgiveness
•Gratitude
•Transcendence
•Expression of faith
 WELLNESS ISSUES
Addressing Spiritual Needs
•Being available
•Honoring beliefs and practices
•Providing opportunities for solitude
•Promoting hope
•Facilitating the discovery of meaning / purpose of
challenging situations
•Facilitating religious practices
•Praying with and for
 CLASS ACTIVITY
• Debate
• Health fair
• Review chapter 7, focus on pages 91-98. be
prepared to discuss the application of
gerontological nursing processes.

• Due date Wednesday, Sept 14.

 REFERENCES
• Eliopoulos, C. (2010). Gerontological Nursing. Philadelphia: Lippincott
Williams & Wilkins.
• Luekenotte, A.G., (2006) Gerontological Nursing. St. Louis: Missouri:
Mosby Inc.
• Ministry of Labour and Social Security., National Policy For Senior Citizens.